Samantha’s pregnancy puts myositis in focus: Is healthy pregnancy with autoimmune disease possible?

When actor Samantha Ruth Prabhu announced that she is expecting her first child, fans celebrated a new chapter in the actor's life. But the news also reignited an important conversation about pregnancy and chronic illness.

Samantha, who revealed in 2022 that she had been diagnosed with myositis, an autoimmune disease, has spoken openly about the physical and emotional challenges of living with the condition. Now, as she prepares for motherhood, many are asking the same question.

Is pregnancy safe for women with autoimmune disorders such as myositis?

To better understand the condition and what it means for women who are planning a family, we spoke to Dr Thasnima Dilshad, a Senior Consultant Gynecologist at Shihab Thangal Hospital, Tirur.

"When we talk about autoimmune disorders, we're referring to a broad group of conditions. Some of the more common ones include systemic lupus erythematosus (SLE), antiphospholipid antibody syndrome (APLA), rheumatoid arthritis, Sjögren's syndrome, and myositis. Among these, myositis is an autoimmune condition that primarily affects the muscles."

What is myositis?

Myositis is a group of rare conditions that cause inflammation in the muscles. In many cases, it is an autoimmune disease, meaning the body's immune system mistakenly attacks healthy muscle tissue.

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The inflammation gradually weakens the muscles, especially those around the shoulders, upper arms, hips and thighs. Everyday activities such as climbing stairs, standing up from a chair, lifting objects or even brushing hair can become difficult.

Some forms of myositis, such as dermatomyositis, can also affect the skin, causing distinctive rashes. In more severe cases, the condition may involve the lungs, heart or muscles used for swallowing.

How myositis can affect everyday life

Unlike temporary muscle soreness after exercise, myositis causes ongoing muscle weakness that can significantly affect quality of life.
Common symptoms include:

• Muscle weakness, especially around the shoulders and hips
• Persistent fatigue
• Muscle pain or tenderness
• Difficulty climbing stairs or getting up from a seated position
• Trouble lifting the arms
• Difficulty swallowing in some cases
• Breathlessness if respiratory muscles are involved
• Skin rashes in certain types of myositis

The condition often comes and goes in periods known as flares and remission. Some people experience long symptom-free periods, while others require long-term medication to keep inflammation under control.

Planning for pregnancy starts long before the positive test

This is one of the most important aspects of pregnancy in women with myositis.

"Women with myositis can absolutely have a healthy pregnancy. However, the key is planning it carefully. Ideally, pregnancy should be planned after the disease has been in remission for at least six months. That significantly improves the chances of a healthy pregnancy for women with autoimmune disorders," said Dr Thasnima.

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Doctors generally recommend trying for pregnancy only when the disease has remained well controlled or inactive for several months. Research suggests that women whose disease is stable before conception tend to have better pregnancy outcomes than those with active inflammation.

"Autoimmune disorders typically go through phases where the disease flares up and phases where it goes into remission. Pregnancy should ideally be planned when the condition is well controlled and in remission. If a woman becomes pregnant during a flare-up, the risk of complications increases. So, when we talk about autoimmune disorders in general, the biggest concern is ensuring that the disease is well controlled before conception and that the pregnancy is closely monitored throughout," she added.

Pre-pregnancy planning usually involves:

• Reviewing disease activity
• Checking whether current medicines are safe during pregnancy
• Stopping or replacing medicines that may harm the developing baby
• Assessing lung, heart and kidney function if required
• Coordinating care between a rheumatologist and an obstetrician experienced in high-risk pregnancies

This does not mean pregnancy is impossible. It simply means preparation can make a significant difference.

Can pregnancy trigger an autoimmune flare?

There is no single answer because autoimmune diseases behave differently from person to person.

Interestingly, pregnancy changes the immune system. Some women notice their symptoms improve during pregnancy, while others remain stable.

A smaller number may experience disease flares either during pregnancy or, more commonly, after childbirth when the immune system shifts back to its usual state.

"Pregnancy itself does not necessarily worsen the condition. However, as I mentioned earlier, autoimmune diseases tend to go through periods of remission and flare-ups. While many women remain stable during pregnancy, there is a higher risk of disease flare-ups after delivery, during the postpartum period. That's why close monitoring is essential, not just during pregnancy but even after childbirth,” said Dr Thasnima.

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This is why regular follow-up appointments throughout pregnancy and the postpartum period are important.

"Care for these patients should always follow a multidisciplinary approach. Along with an obstetrician, a rheumatologist should be involved throughout the pregnancy. In conditions such as myositis, the lungs can also be affected because the disease may involve the muscles responsible for breathing. In such cases, a pulmonologist should also be part of the care team.”

"When specialists work together and closely monitor both the mother and the baby, women with autoimmune disorders can have much safer pregnancies and better outcomes," she explained.

It is also worth remembering that fatigue is common during pregnancy itself. For women with myositis, distinguishing between normal pregnancy tiredness and a disease flare may not always be straightforward, making medical supervision essential.

What are the potential risks for the mother?

If myositis is active during pregnancy, the mother may face additional challenges, including:

• Increased muscle weakness
• Greater fatigue
• Difficulty with mobility
• Increased chance of disease flare
• Breathing or swallowing difficulties in severe cases
• Medication adjustments during pregnancy

"For the mother, the risks depend on the specific autoimmune condition. In myositis, the body's immune system produces autoantibodies that mistakenly attack healthy muscle tissue. This can lead to muscle weakness, which is one of the main symptoms of the disease."

"In some cases, myositis can affect muscles beyond the arms and legs. If the muscles involved in breathing are affected, it can lead to lung-related complications. The disease can also involve the heart muscle, causing problems such as myocarditis. These complications can become serious if they are not recognised and managed early,” the doctor said.

Are there risks for the baby?

Most women with well-controlled myositis deliver healthy babies.

However, active autoimmune disease has been linked to a higher risk of certain pregnancy complications, including:

• Preterm birth
• Low birth weight
• Restricted fetal growth
• Pregnancy loss in some high-risk cases

"For the baby, uncontrolled autoimmune disease can increase the risk of restricted foetal growth, preterm birth, low birth weight and, in some cases, miscarriage. There is also a higher risk of pregnancy complications such as pre-eclampsia, which is characterised by high blood pressure during pregnancy,” said Dr Thasnima.

The level of risk depends on several factors, including how active the disease is, the mother's overall health and whether other organs are affected. Regular scans, blood tests and antenatal monitoring help doctors identify any problems early.

"However, with proper treatment and regular follow-up through a multidisciplinary team involving an obstetrician, rheumatologist and, when necessary, a pulmonologist and cardiologist, both the mother and the baby can have much better outcomes," she said.

Can women with myositis take medicines during pregnancy?

Some medicines used to treat myositis can be safely continued during pregnancy, while others are known to increase the risk of birth defects and must be stopped well before conception.

"There can be complications related to the disease itself, and some of the medications used to control autoimmune disorders may also need to be reviewed. Treatments such as steroids, azathioprine and hydroxychloroquine are commonly prescribed, and while some of these medicines are considered safe during pregnancy, others may require adjustments depending on the individual case," the doctor stated.

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For this reason, experts strongly advise against discontinuing medication without medical advice. Suddenly stopping treatment can trigger a flare, which may be more harmful than continuing pregnancy-safe medication. Treatment decisions are always individual and should be made jointly by the rheumatologist and obstetrician.

A pregnancy that needs a team effort

Women with myositis are often encouraged to:

• Attend all antenatal appointments
• Take prescribed medication exactly as advised
• Eat a balanced diet
• Stay physically active within their doctor's recommendations
• Get enough rest
• Report any new weakness, breathing problems or reduced fetal movement immediately
• Continue follow-up after delivery because flares can occur in the postpartum period

Samantha Ruth Prabhu's pregnancy is a reminder that living with an autoimmune condition does not automatically mean giving up the dream of becoming a parent.

Pregnancy with myositis may need a little more planning and a few more hospital visits than usual. But with the right care and support, many women are able to enjoy a healthy pregnancy and welcome a healthy baby.

An autoimmune diagnosis may change the path to motherhood, but for many women, it does not close the door.